No matter what your age, stress can affect you. Whether it’s a student worried about an exam, an employee worried about meeting a deadline, or a woman affected by the sudden changes in her body—everyone worries. But women over 40 years are more prone to stress and anxiety. Midlife issues such as menopause, caring for ageing parents, career changes, children leaving home and financial setbacks make ageing women the perfect target for stress related problems. Anxiety, depression and mood swings are few of the first signs of perimenopausal transitions. Let’s take a look at each of them more closely.

Anxiety

There are many emotional factors particular to perimenopause that can contribute to anxiety. When perimenopause hits, a woman is likely to suffer from anxiety as well as depression. Anxiety is a mental state where you worry too much—sometimes persistently—are nervous and tense. You can’t seem to shake off your concerns and worries about everyday events even though you know that your anxiety is unjustified. You can have difficulty concentrating and feel restless and irritable, which can sometimes lead to panic attacks. Changes in oestrogen levels have a direct effect on the neurochemicals that regulate mood. Hence, fluctuations in them can lead to anxiety. Other social factors, like worrying about your child’s exam results, may worsen this condition. Managing this condition requires a lot of family support and understanding, lifestyle changes and sometimes also medication.

Even for those women who are essentially happy and upbeat, things may change quickly and drastically when perimenopause appears. It’s a time of emotional distress. Because of this, they have more conflicts than usual with the people around them and that creates tension. At this stage, some women even go through a difficult time with their husbands sexually, which further aggravates anxiety. The problem may also be aggravated by caffeine, stress, thyroid problems, or heart disease.

Anxiety leads to palpitations or rapid heartbeats. It is a good idea to visit a physician and have a thorough check-up done if the heartbeat is faster than 100 beats per minute. If all your tests are normal, try yoga and relaxation techniques and avoid caffeine, colas, smoking and alcohol—these steps will help reduce episodes of palpitations.

Depression

Women over the age of 40 go through a lot of changes that can give rise to depression in them. This doesn’t mean that every woman over 40 will get depressed. But if your life was already stressful, the physical and emotional changes that typically accompany menopause may send you into a full-blown state of depression.

Depressive illness can make you feel exhausted, worthless, helpless and hopeless, and sometimes you may just want to give up. Women often suppress their need of autonomy, neglect their health, and fail to equip with skills, competence and self-confidence.

They may experience sadness, crying spells, sleeplessness or excessive fatigue, lack of interest in surroundings, neglect of self and display other signs of depression which may be as serious as suicide attempts. Treatment consists of lifestyle changes, exercise, yoga, support from family and friends and often anti-depressant drugs.

Appearance becomes a confidence-booster during menopause

Mood fluctuations

Frequent mood change is the most common symptom of perimenopause. As a teenager, some of you may have cried at the drop of a hat. As a woman in your 30s PMS made you bite your best friend’s head off when she asked you how your day went. Or remember-that feeling of wanting to punch someone because they just wouldn’t shut up when you told them to? Well, that feeling is going to come back to you when you least expect it, in circumstances that may at times be classified as volatile. We’d all like to keep these episodes to a minimum, but perimenopause can sometimes make that seem like an impossible challenge. Perimenopause shares many of these symptoms with PMS. The difference is that PMS lasts only for one week, once a month, but perimenopause can last anywhere from 1 to 10 years. It’s no wonder that the overriding emotion women in their 40s feel is that of being overwhelmed.

And because you have to train yourself to cope with these feelings, perimenopause also results in a pretty drastic change in a woman’s personality. There are days when you don’t really know what is happening with you. You’ll find yourself annoyed by things that you never even noticed. I have had patients who are very disturbed by the changes that are taking place because they’re shocked by the fierceness of their irritability and the sharpness of their mood swings. Wild mood swings and increased irritability are linked to the sudden shifts in hormonal balance. These fluctuations in the levels of oestrogen, testosterone, and progesterone can occur when your body doesn’t get the right kind of support to maintain a natural balance. Sometimes, mood swings can take you high and you feel intense joy in everything around you. At other times, however, they can take you on a downhill ride with emotions such as sadness, anger, despair, anxiety, or fear.

A mental shift

40s are a time when many women find themselves at the peak of their career. While the 20s were spent trying to climb the ladder of success, the 30s were about consolidating your presence in the workplace. But it’s in your 40s, that it all comes together for you. This also means added pressure and stress.

For homemakers too, this is the time when they begin to assert their independence. By this age, a woman realises that time has passed her by and that she now has to make some changes in her life. Many women show a lot more independence now than they ever did. When they were younger, they were dependant on their husband or parents. There’s the feeling that they couldn’t do much to change their situation because the kids were too young. So if they are not happy in their relationships, this is the time that they assert themselves.

But that assertiveness can have a dark side too. I’ve noticed that for certain women, this phase brings out a side of their personality that was dormant for several years.

Let me give you an example. My husband and I have been friends with a couple for many years now. Theirs was a love marriage and they have two children who are in their teens. Ever since we’ve known them, this couple has been very happy. But about three to four years ago, I noticed a change in the attitude of the wife. A woman who for so long was happy to just be known as someone’s wife, suddenly was coming into her own. She seemed more confident and was very focused on her appearance. Whenever the two of us would meet for lunch, she’d only talk about how it was important to be your own person and that now she was keen to do things her own way. She had always been slightly plump, but now she was an active member at her gym and exercised regularly. She had become a completely different person from the one I had known for so many years. I was glad that she was happy with the changes she had made in her life, but was also taken aback by the aggression behind those changes. Soon after, her husband told me that she had been having an affair with a man she met at the gym, and that they were on the verge of separation.

After years and years of making adjustments to live according to how their husbands and in-laws want them to, during their 40s women realise that there’s more to life. The realisation that the person they have moulded themselves to be is not what they started out as can be very crushing. And then they feel a need to rebel.

One of the reasons for this is that women in their 40s often have a lot of free time at hand and don’t know what to do with it. If you aren’t a working woman, you may have a ‘vacuum’ in your life at this stage. That’s why I always encourage women to work. At 25, if you aren’t a working woman, you may feel empty when you are older. Starting work at 40, when you have no skills or experience, is not easy! 40s is also the time when women try to reclaim old friends. Indian women tend to lose touch with their school friends after they get married. But suddenly, in their mid-40s, they reconnect with old friends because they have time on their hands. So now, a woman has a social circle of her own that’s not dependant on her husband.

That’s probably why, as I have observed, a lot of couples experience trouble in their marriage in their 40s. Whether they divorce or not depends on their individual mindsets as well as what their social environment allows them to do.

Anthropologist Margaret Mead said, “There is no greater power in the world than the zest of a menopausal woman.” The symptoms you feel through perimenopause ultimately influence your actions and reactions. Don’t let these symptoms define you during this stage of your life. The power to help yourself during this time lies with the best person—you.

This was first published in the April 2015 issue of Complete Wellbeing

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